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Toxic megacolon (TM) is defined as total or non-segmental obstructive dilatation of the colon to an external diameter of 6.0 cm or greater, associated with systemic toxicity. It is a potentially fatal condition that represents the end of a spectrum of severe colitis. Typically a complication of ulcerative colitis, it is also seen as a consequence of infective colitis. Of particular concern, due to...
Small bowel ischaemia can present acutely as an abdominal surgical emergency or as a more chronic condition, usually due to slow atherosclerotic occlusion of the visceral arteries. Early diagnosis of acute bowel ischaemia is essential. Other common causes of acute abdominal pain must be ruled out. CT scanning is the key investigation with an approximate 90% sensitivity and specificity. Plasma markers...
Acute upper gastrointestinal (GI) haemorrhage is one of the most common GI emergencies. Bleeding from peptic ulcer disease and variceal haemorrhage are the most frequently observed causes of haemorrhage. Mortality is increased in the elderly, patients with liver disease and those who present with shock. The use of risk stratification scores such as the Glasgow Blatchford or Rockall scores is recommended...
Acute pancreatitis is an inflammatory condition with a variable clinical course. Diagnosis is based upon clinical presentation, laboratory indices and imaging studies, whilst illness severity can be assessed by clinical scoring systems, such as the Ranson, Glasgow or APACHE II criteria, or by radiological assessments such as the CT severity index. Most patients develop self-limiting disease but a...
Anaemia related to the digestive system is mostly secondary to dietary deficiency, malabsorption, or chronic bleeding. We review the World Health Organization definition of anaemia and its morphological classification (microcytic, macrocytic and normocytic). We detail the importance of iron, vitamin B 12 and folate deficiency anaemia; the interpretation of laboratory tests to differentiate...
Oesophageal emergencies are relatively rare but their management leaves little room for error. This article explains the aetiology, diagnosis and management of oesophageal bleeding, obstruction, perforation and caustic injury. The essential role of early flexible endoscopy and specialist multi-disciplinary care is emphasized.
Symptoms of lower gastrointestinal (GI) disease are common and frequently trigger consultation in primary and secondary care. Diarrhoea, abdominal pain and constipation are presentations of a wide range of different underlying pathologies, from chronic, benign, functional conditions to acutely life-threatening emergencies. Lower GI bleeding is often due to serious pathology and requires rational investigation...
Patients with upper gastrointestinal (GI) disease present with diverse symptoms, which are linked to significant morbidity and relatively few reliable signs. Upper GI pathology may present as an acute abdomen, when clinical diagnostic accuracy is approximately 50%. The aim of this article is to provide a systematic approach for formulating a differential diagnosis in patients with common symptoms...
Acute lower gastrointestinal bleeding often presents a challenging clinical situation. Bleeding may be severe and associated with significant haemodynamic compromise, and yet usually stops spontaneously. The causes are various, and the bleeding source may be difficult to identify, even with sophisticated diagnostic methods. Colonoscopy, CT angiography, mesenteric angiography and capsule enteroscopy...
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